You can use this form to request a repeat of medication that we prescribe for you for an ongoing health condition.

Repeat prescriptions are at the discretion of the doctor who may request that you make an appointment. If an appointment is required a nurse/receptionist will ring or text to arrange a suitable time.

The standard charge for a repeat prescription is $22 for an adult; $10 for a 13 -17 yr old; or free for under 13 year olds. If you would like your prescription faxed to a pharmacy we can arrange this at an extra charge of $5 – you will need to provide the contact details for the pharmacy. We take prescriptions to Whitby Pharmacy free of charge (on request only).

Please allow at least 48 hours between placing your request and collecting your prescription from the front desk.

If you require a prescription on the day you need to ring and speak to or leave a message for the nurse, there is an additional charge for same day prescriptions.



Your Full Name (required)

Your Date of Birth (required)

Your Email (required)

Your Phone Number (required)

Your Address

How would you like us to confirm your request?
 Email Phone Text Message

Allergy to medication (please list):

What over the counter pharmacy medication are you currently taking? (Leave blank if none)

What herbal or alternative medication are you currently taking? (Leave blank if none)

Medication Name Dosage
(eg 120mg tablet)
Frequency
(eg 1 tablet twice a day)
Supply
(eg 3 months)
Used for
(eg blood pressure)

Any other information?

Please answer the following math question to confirm you are an actual person
1+1=? 

You will receive confirmation of your repeat medication request via your chosen method.